Chloral. Chloral Hydrate.

The name Chloral is authorized when Chloral hydrate is intended. If Chloral proper is intended, the U. S. Dispensatory specifies Anhydrous Chloral.

The influence of Chloral in full therapeutic doses is exercised in the production of sleep. If it be taken on a comparatively empty stomach the patient becomes quiet in half an hour, and the sleep lasts from two to six hours, according to the previous condition of the mind, whether tranquil or disturbed. It usually produces a dreamless, natural sleep, followed by few unpleasant symptoms. Occasionally, however, the dose fails, and the second or third dose is necessary.

At other times it produces cerebral distress or headache, nausea, faintness and extreme lassitude. There is no marked apparent influence upon the pulse or respiration in normal cases, but the pupil contracts somewhat. During the period of induced sleep the patient may be awakened to full consciousness, may take food, may even transact items of business, and then lie down and almost immediately fall into a continued natural sleep. Cough is not always allayed by it, and this may awaken the patient, or a desire to urinate may awaken him.

Chloral has but little influence over pain. It may be given during pain to induce sleep. If that result is accomplished by sufficient dosage, the patient's countenance shows the presence of pain, and he will complain upon waking of its having continued during his sleep.

Greatly prolonged use of chloral produces impairment of the appetite, bad taste in the mouth and bad breath, with fetid fecal discharges, deficient secretion of the gastric and biliary fluids, and an increase of the nervous phenomena for which it is usually prescribed; also an eruption, irritation or ecchymosis and red rash of the skin with desquamation. It permanently abates both mental and physical vigor.

Contra-Indications—Chloral is contra-indicated in feebleness with exhaustion, or when there is a tendency to stupor or coma or general dullness, and in cerebral anemia. It is contra-indicated in weak heart, especially if existing in alcoholism.

Specific Symptomatology—The direct influence of chloral is that of a profound nerve sedative and a producer of quiet, restful and natural sleep. In its influence over the muscular system it produces profound relaxation similar to that of gelsemium, but attended in extreme cases, or where the heart is feeble, with more danger.

Therapy—It is a promoter of quiet and repose in all conditions of nervous excitability and extreme restlessness. In the excitement and noisy delirium of fevers no agent acts more satisfactorily. It quiets excitement, overcomes the delirium if due to cerebral engorgement and induces normal sleep.

It is a superb remedy in the sleeplessness of inflammatory fevers, and in the earlier stages of typhoid and other continued fevers, except in the later or asthenic stages when the vital force is exhausted when it must not be given.

Chloral will induce sleep in chorea, and during the sleep the symptoms will abate, but it does not cure the difficulty.

Chloral is of much value in hysteria and the nervous phenomena of this condition. It is best given in conjunction with a stimulant in asthenic cases, as it possesses no inherent stimulating properties.

It is a reliable remedy in pruritus from nervous causes, especially Pruritis vulvae of pregnancy, with nervous erethism which causes increased nervous phenomena and. prevents sleep. One or two doses of fifteen grains will often control the condition for a day or two.

In puerperal convulsions chloral is a reliable remedy and has been often used in the past.

In rigid os uteri, with or without general nervous irritation, with hot vagina and irritable nagging pains, and no advancement of the labor, chloral is a useful remedy. Fifteen grains repeated if necessary in half an hour will usually cause an entire change in the condition. It will quickly relax the rigid os and change the character of the pains. It will quiet the nervous excitement and secure an interval of restful sleep.

It acts promptly in such a case if a diluted solution of twenty or thirty grains be injected into the rectum, previously evacuated with a hot enema. It does not in these doses usually interfere with uterine contractions or subsequent involution.

It is a useful hypnotic in the sleeplessness of the aged, with whom small doses exercise a satisfactory influence. The influence of chloral upon children, in small doses of from one to three grains is very soothing. In nervous and restless children with disturbed sleep, children who toss about during the entire night or cry out frequently, or awake in terror, this agent has a charming influence. A small dose should be given an hour before bedtime and repeated as the child is put to bed-from one-fourth to three-fourths of a grain each year of the child's age. This should be repeated on two or three consecutive nights, if no unpleasant symptoms appear, when the bad habits will be temporarily broken. On their reappearance it may be resumed again for a night or two. The cause of the restlessness should be discovered and relieved also.

Chloral is an excellent remedy in convulsions of children. It is safe in proper doses and powerfully antispasmodic. In combination with the sodium or potassium bromides, a solution may be kept at hand for emergencies, and will prevent approaching spasm and promptly control those existing. It will allay nervous twitchings and other evidences of nerve irritation, and will soothe and quiet the patient and induce refreshing sleep. It is not to be given if the convulsions occur from exhaustion or after prostrating disease.

As we have learned our vegetable anti-spasmodics better, we depend on these with results so nearly perfect that we seldom think of the inorganic agents though potent and controllable.

Chloral is useful in whooping cough and in the paroxysm of spasmodic asthma. It will relieve asthmatic dyspnea occasionally when dependent upon nerve irritation.

It is used in epilepsy with advantage. In nocturnal petit mal, if the attack can be anticipated, a full dose at the bed hour will usually ward it off.

In tetanus chloral has been in quite common use, full doses being necessary. A physician whose name we have now lost, reported several years ago that he had cured several cases of traumatic tetanus by opening the wound freely and filling it with finely-powdered chloral to the extent of sixty grains.

It is a reliable agent in delirium tremens, and in acute mania and in the paralysis of the insane. It soothes excitability as well as induces sleep.

Theoretically, chloral should prevent the excretion of sugar in the urine in diabetes mellitus. In practice, a few cases only have been so benefited. It deserves further investigation in this line.

Chloral is not a remedy for hypodermic injection; it produces local irrita.tion and abscess. It has been advised for use by intravenous injection in the treatment of tetanus, puerperal convulsions, strychnine poisoning, and hydrophobia, but such care is demanded in its use that it has not received general adoption. Further investigations may prove its benefits.

Chloralamide is a derivative of anhydrous chloral. It is given in doses of five to thirty grains, and is prescribed for the same conditions as chloral. It is not so depressing on the heart, nor as irritating to the stomach.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.